American Journal of Rhinology & Allergy最新文献

{"title":"Neurectomy Versus Ablation of Posterior Nasal and Anterior Ethmoidal Nerve for Allergic Rhinitis: A Prospective Randomized Comparative Study.","authors":"Shanshan Zhang, Yihan Chen, Jianhui Zhao, Jun Han, Yibei Wang, Yiding Liu, Jianfeng Liu","doi":"10.1177/19458924261429542","DOIUrl":"https://doi.org/10.1177/19458924261429542","url":null,"abstract":"<p><p>ObjectiveTo evaluate and compare the efficacy and safety of endoscopic neurectomy versus radiofrequency ablation targeting both the posterior nasal nerve (PNN) and lateral internal nasal branches of the anterior ethmoidal nerve (LINB-AEN) in patients with allergic rhinitis (AR).MethodsIn this prospective randomized controlled trial, adult patients with moderate to severe AR undergoing endoscopic nerve intervention from November 2023 to September 2025 were randomized to receive either neurectomy or ablation. Surgical targets included both PNN and LINB-AEN. Outcomes were assessed at 1, 3, and 6 months postoperatively and included nasal symptom visual analog scale (VAS), total nasal symptom score (TNSS), rhinoconjunctivitis quality of life questionnaire (RQLQ), total nasal resistance (TNR), olfactory function (VAS, QOD-NS, and Sniffin' Sticks), and adverse events.Results61 patients completed follow-up (neurectomy group: n = 30; ablation group: n = 31). Both groups achieved significant symptomatic improvement by 6 months (<i>p</i> < 0.001). The ablation group demonstrated significantly greater improvement in nasal obstruction (<i>p</i> < 0.001) and sneezing (<i>p</i> = 0.008) at 1 month, while the neurectomy group showed earlier improvement in rhinorrhea (<i>p</i> = 0.002). Both procedures improved nasal resistance. Neurectomy provided a faster, sustained nasal resistance improvement (<i>p</i> _{3 months} = 0.001, <i>p</i> _{6 months} = 0.003) with superior improvement in odor identification (<i>p</i> < 0.001) and TDI score (<i>p</i> = 0.005). Notably, no serious complications were reported. Additionally, symptoms of nasal dryness improved from baseline in both groups.ConclusionThis is the first randomized controlled study to compare dual-target endoscopic neurectomy and ablation for AR. Both approaches are effective and safe. Ablation offers faster symptom relief, while neurectomy provides superior long-term control of nasal airflow and olfactory function. Individualized surgical planning is recommended based on symptom profile and patient preference.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2500111543Level of Evidence2.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"19458924261429542"},"PeriodicalIF":2.3,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Interpretation of a Machine Learning-Based Predictive Model Using Clinical Parameters for Eosinophilic Chronic Rhinosinusitis With Nasal Polyps.","authors":"Longyan Liu, Shufen Pei, Zengping Liu, Yanli Wang, Wenjuan Ding, Yuli Zhao, Yong Li, Xingjian Chen, Wenbin He, Shihong Duan","doi":"10.1177/19458924261425834","DOIUrl":"https://doi.org/10.1177/19458924261425834","url":null,"abstract":"<p><p>ObjectiveWe aim to predict eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) employing preoperative clinical parameters and machine learning algorithms, evaluating, and selecting the optimal model.MethodsRetrospective collection of preoperative clinical parameters from 331 individuals suffering from chronic rhinosinusitis with nasal polyps. Independent predictors for ECRSwNP were determined through the application of the least absolute shrinkage and selection operator in conjunction with multivariate logistic regression. Four ML models for classification were constructed and cross-validated through the training set (223 patients), with predictive performance further evaluated on the testing set (98 patients). Shapley additive explanations (SHAP) technology provides importance rankings for predictive variables and explains personalized predictions from optimal models. Net reclassification improvement and integrated discrimination improvement values assessed the improvement in predictive performance. The prognostic value of the model further validated through Kaplan-Meier analysis.ResultsPeripheral eosinophil percentage, visual analog scale, ethmoid/maxillary sinuses ratio, and nasal polyps score were identified as key variables for model construction. Extreme gradient boosting (XGBoost) proved to be the superior prediction model, attaining an area under the receiver operating characteristic curve of 0.981 in the training cohort and 0.928 in the testing cohort. The model demonstrated optimal net benefit across various risk thresholds and effectively predicted postoperative recurrence in patients with ECRSwNP.ConclusionWe constructed an XGBoost predictive model and visualized its interpretation using the SHAP method, providing a reference for preoperative noninvasive assessment of ECRSwNP patients and guiding individualized treatment.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"19458924261425834"},"PeriodicalIF":2.3,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Pathogenic Bacteria on Postoperative Nasal Function and Risk Factors for Recurrence in Chronic Rhinosinusitis With Nasal Polyps After Endoscopic Sinus Surgery.","authors":"Yan Zhang, Xiaomeng Liu, Bi Qiang, Xianmo Wang","doi":"10.1177/19458924261416669","DOIUrl":"https://doi.org/10.1177/19458924261416669","url":null,"abstract":"<p><p>Background and ObjectivesTo investigate the impact of pathogenic bacterial distribution in the nasal cavity on postoperative nasal function recovery in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) after endoscopic sinus surgery (ESS), and to analyze the risk factors for postoperative recurrence.MethodsA total of 178 CRSwNP patients who underwent ESS in our hospital from May 2021 to May 2023 were selected. Based on preoperative nasal secretion pathogen culture results, patients were categorized into the pathogen-negative group (42 cases), bacterial-positive group (90 cases), and fungal-positive group (46 cases). The nasal symptom visual analogue scale (VAS) score, Lund-Kennedy endoscopic score, and Lund-Mackay computed tomography (CT) score were assessed preoperatively and at 12 weeks postoperatively. Patients were followed up for 24 months and categorized into the recurrence group (36 cases) and the recurrence-free group (142 cases) based on postoperative recurrence. Relevant risk factors for recurrence were analyzed.ResultsAmong the 178 patients, the bacterial positivity rate was 50.56% (mainly <i>Corynebacterium</i>, <i>Staphylococcus</i>, and <i>Haemophilus influenzae</i>), while the fungal positivity rate was 25.84% (mainly <i>Candida albicans</i> and <i>Aspergillus</i>). Postoperatively, the nasal symptom VAS scores for individual items, Lund-Kennedy endoscopic scores, and Lund-Mackay CT scores showed significant improvement compared to preoperative values (<i>P</i> < 0.05). Comparisons among the 3 groups revealed a trend of pathogen-negative group < bacterial-positive group < fungal-positive group in nasal symptom VAS scores, Lund-Kennedy endoscopic scores, and Lund-Mackay CT scores, with significant differences observed between each pair of groups (<i>P</i> < 0.05). Univariate analysis showed that the proportions of asthma, history of revision surgery, eosinophilic (EOS)-type nasal polyps, and preoperative Lund-Mackay CT scores were all higher in the recurrence group than in the recurrence-free group (<i>P</i> < 0.05). Multivariate analysis identified history of revision surgery (OR = 6.963, 95% CI: 2.275-21.313), EOS-type nasal polyps (OR = 4.566, 95% CI: 1.449-14.392), and high preoperative Lund-Mackay CT scores (OR = 1.928, 95% CI: 1.475-2.522) as independent risk factors for postoperative recurrence (<i>P</i> < 0.05). <i>Corynebacterium</i> infection might reduce the risk of recurrence (<i>P</i> = 0.065).ConclusionNasal bacterial and fungal colonization in patients with CRSwNP are associated with poor postoperative nasal function recovery, with fungal colonization leading to the worst prognosis. Postoperative recurrence is closely related to EOS-type nasal polyps, a history of previous surgery, and a high preoperative Lund-Mackay CT score. <i>Corynebacterium</i> may serve as a protective microbial population.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"19458924261416669"},"PeriodicalIF":2.3,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Roles of IFN-γ, IL-17, and Peripheral Blood Neutrophils in Olfactory Dysfunction in Non-Eosinophilic CRSwNP.","authors":"Zhidi Zhang, Qiang Zuo, Hailing Jiang, Yingting Qi, Yinghong Zhang","doi":"10.1177/19458924261428330","DOIUrl":"https://doi.org/10.1177/19458924261428330","url":null,"abstract":"<p><p>BackgroundOlfactory dysfunction (OD) is a significant symptom in non-eosinophilic chronic rhinosinusitis with nasal polyps (neCRSwNP), but its non-type 2 inflammation-driven mechanisms remain unclear.ObjectiveTo investigate the roles of local nasal non-type 2 inflammatory cytokines and systemic immune indicators in neCRSwNP-associated OD.MethodsSeventy-nine neCRSwNP patients were enrolled and divided into neCRSwNP with OD (neCRSwNP-wOD, n = 49) and neCRSwNP without OD (neCRSwNP-woOD, n = 30) groups. Olfactory function was assessed using the T&T Olfactometer. Nasal mucus cytokines (IFN-γ, TNF-α, IL-1β, IL-17) were measured by ELISA. Peripheral blood inflammatory indicators including absolute neutrophil count (Neut), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), were analyzed. Statistical methods included the Mann-Whitney U test, Spearman correlation analysis, multivariate logistic regression, and ROC curve analysis.ResultsNasal IFN-γ and IL-17 levels were significantly elevated in the OD group (both P < 0.05), while TNF-α and IL-1β showed no difference. Patients with OD also exhibited higher Neut, NLR, and SII (all P < 0.05). Olfactory scores strongly correlated with Neut (r = 0.639, P < 0.01) and moderately with IFN-γ (r = 0.533, P < 0.01). Multivariate regression identified IFN-γ, IL-17, and Neut as independent risk factors for OD. ROC analysis indicated that Neut had the highest predictive accuracy (AUC = 0.839), and a combined model of three indicators (Lund-Kennedy score, IL-17 and Neut) achieved excellent diagnostic performance (AUC = 0.964).ConclusionOlfactory dysfunction in neCRSwNP is associated with the combined involvement of local Th1/Th17 pathway activation (IFN-γ/IL-17) and neutrophil-mediated systemic inflammation. IFN-γ, IL-17, and peripheral blood neutrophils may be involved in the development of olfactory dysfunction in neCRSwNP.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"19458924261428330"},"PeriodicalIF":2.3,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Outcomes of Posterior Nasal Nerve Ablation and Inferior Turbinate Radiofrequency During Septoplasty in Patients with Allergic Rhinitis: A Prospective Study.","authors":"Enes Dogan, Serdar Özer","doi":"10.1177/19458924261428331","DOIUrl":"https://doi.org/10.1177/19458924261428331","url":null,"abstract":"<p><p>BackgroundThe efficacy of adjunctive procedures targeting allergic rhinitis (AR) symptoms during septoplasty remains controversial. While radiofrequency ablation of the inferior turbinates (ITRA) is commonly performed, its impact on allergic symptoms beyond nasal obstruction is limited. Posterior nasal nerve ablation (PNNA) has recently gained attention as a promising alternative.ObjectiveTo compare the effects of PNNA and ITRA performed concurrently with septoplasty on allergic and obstructive nasal symptoms in patients with septal deviation and AR.MethodsThis prospective cohort study included 69 patients with septal deviation and AR who underwent septoplasty with either PNNA (<i>n</i> = 35) or ITRA (<i>n</i> = 34). Symptoms were assessed preoperatively and at 3 months postoperatively using the Mini-Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ), reflective Total Nasal Symptom Score (rTNSS), and Nasal Obstruction Symptom Evaluation (NOSE) scale. The rTNSS was divided into obstruction-related (rTNSS-A) and allergic (rTNSS-B) sub scores.ResultsBoth groups showed significant postoperative improvement in all parameters (<i>p</i> < 0.001). Compared with ITRA, the PNNA group demonstrated greater reductions in MiniRQLQ (<i>mean changes</i> <i>=</i> <i>36.97</i> <i>±</i> <i>12.4 vs 32.00</i> <i>±</i> <i>11.8; p</i> <i>=</i> <i>0.025</i>), rTNSS-B (<i>median changes</i> <i>=</i> <i>4.0 vs 2.0; p</i> <i><</i> <i>0.001</i>), and rTNSS (<i>median changes</i> <i>=</i> <i>4.0 vs 2.5; p</i> <i><</i> <i>0.001</i>). Changes in rTNSS-A and NOSE scores were comparable between groups (<i>p</i> > 0.05). No serious adverse events occurred; transient crusting was observed in 5 ITRA and 3 PNNA patients, and mild bleeding in 2 ITRA patients.ConclusionBoth techniques effectively improved nasal symptoms, but PNNA provided superior relief of allergic symptoms and quality-of-life gains, supporting its consideration as an adjunctive treatment in septoplasty patients with comorbid AR.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"19458924261428331"},"PeriodicalIF":2.3,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Comorbid Dysautonomia on Postoperative Complications in Sinonasal Surgery.","authors":"Emaan Dawood, Arman Saeedi, Theodore A Schuman","doi":"10.1177/19458924251413870","DOIUrl":"https://doi.org/10.1177/19458924251413870","url":null,"abstract":"<p><p>BackgroundDisorders of autonomic dysregulation appear increasingly prevalent in chronic rhinosinusitis (CRS).ObjectiveThe purpose of this study was to investigate if dysautonomia portends a riskier postoperative course in patients with CRS undergoing sinonasal surgery.MethodsThe TriNetX database was queried for patients with CRS with or without comorbid dysautonomia undergoing functional endoscopic sinus surgery, septoplasty, and/or inferior turbinate reduction. Cohorts were propensity-matched based on age, gender, race, and potentially confounding comorbid conditions. Main outcome measures were emergency department utilization, inpatient admission, incidence of postoperative cerebrospinal fluid leak, epistaxis, or hypotension. The use of opioid, neuropathic, antibiotic, benzodiazepine, muscle relaxant, corticosteroid medications, and intravenous fluids within 90 days of surgery were also recorded.ResultsEach group contained n = 1122 patients. The dysautonomia group had higher risks of epistaxis (odds ratio [OR]: 2.03; confidence interval [CI]: 1.13, 3.66; <i>P</i> = .016) and neuropathic medication use (OR: 2.92; CI: 1.35, 6.31, <i>P</i> = .005) following sinonasal surgery.ConclusionPatients with CRS and comorbid dysautonomia appear at a greater risk of postoperative epistaxis and neuropathic pain medication use following sinonasal surgery. Although further study is necessary, these findings suggest patients with dysautonomia may have a higher rate of postoperative bleeding and increased pain sensitivity.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"19458924251413870"},"PeriodicalIF":2.3,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Microplastic Inhalation on Allergic and Nonallergic Rhinitis.","authors":"Yesim Itmec, Aysegul Tuna, Ayse Fusun Kalpaklioglu, Ayse Baccioglu","doi":"10.1177/19458924251357135","DOIUrl":"10.1177/19458924251357135","url":null,"abstract":"<p><p>BackgroundMicroplastics are increasingly prevalent in daily life. While their adverse effects on health are well-known, their specific role in rhinitis has not been fully established.ObjectiveIt is known that microplastics suspended in the air have toxic effects on cells through inhalation. The primary aim of this study was to investigate the presence of microplastics in nasal lavage samples from patients in both allergic rhinitis (AR) and nonallergic rhinitis (NAR) groups.MethodsDemographic data, allergy test results, respiratory function tests, mini-Rhinoconjunctivitis Quality of Life Questionnaire and Total Nasal Symptom Score of patients aged 18 to 65 years who applied to the allergy clinic were recorded. Nasal lavage fluid (NLF) samples were collected with physiological serum and placed in glass tubes for all cases. After the filtration process of the samples, microplastic counting was performed under a Stereomicroscope.ResultsA total of 90 subjects (AR: 30, NAR: 30, controls: 30), 64.4% females, within the mean age of 30.27 ± 10.53 years were investigated. Microplastic density in NLF was higher in all rhinitis patients (<i>n</i>: 60) with no difference between AR and NAR than controls (all rhinitis = 3.10 ± 1.00 particles/mL, AR = 3.23 ± 1.29 particles/mL, NAR = 2.97 ± 0.57 particles/mL, controls = 1.18 ± 0.52 particles/mL, <i>P</i> < .001). Microplastic density was higher in young subjects than in older ones (values are \"years; particles/mL\"; 18-30; 2.79 ± 1.22, 31-45; 2.18 ± 1.13, 46-60; 1.5 ± 1.09, <i>P</i> < .05). In logistic procedures, microplastic density of NLF (OR = 2.20, 95% CI [1.02 to 4.75], <i>P</i> = .04) determine the likelihood of sneezing.ConclusionsIn this study, regardless of allergy or nonallergy, higher microplastic density was found in NLF of rhinitis patients than healthy individuals. We also found quantifiable and noteworthy concentrations of microplastics in the nasal lavage of control group. These results support the idea that microplastics cause inflammation in the upper airways.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"98-104"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of the Questionnaire of Olfactory Disorders-Negative Statements in Age-Related Olfactory Dysfunction.","authors":"Alexander Duffy, Zachary M Soler, Kristina A LaPointe, Rod J Schlosser","doi":"10.1177/19458924251382100","DOIUrl":"10.1177/19458924251382100","url":null,"abstract":"<p><p>BackgroundOlfactory dysfunction (OD) is both under-recognized and underdiagnosed in aging adults. Prior studies in chronic rhinosinusitis have demonstrated a correlation between the Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS) and psychophysical olfactory testing, indicating potential utility for screening in this group. This study examined the correlation between QOD-NS scores, psychophysical function, and olfactory-associated patient-reported outcome measures (PROMs) in a novel, aging population. Additionally, we examined the potential utility of the QOD-NS as a screening instrument in this population.MethodsProspective cohort study in which healthy, adult volunteers completed the QOD-NS, olfaction-related visual analog scale (VAS) questions, Sniffin' Sticks (TDI), De Jong Giervald Loneliness Scale, UCLA loneliness survey (UCLA), and the Patient Health Questionnaire-9 (PHQ9).ResultsTwo-hundred and twenty-eight adults with mean age 50.3 ± 17.7 years were included. Subjects ≥50 years old had higher prevalences of hyposmia (58.3% vs 19.8%, P < 0.001) and anosmia (9.1% vs 3.1%, P < 0.001), and had worse QOD-NS and VAS (P < 0.001 for both). Aging subjects had significant correlations between QOD-NS and TDI (r = -0.386, p < 0.001), all VAS scores (P < 0.001), PHQ9 (r = 0.283, P = 0.001). Receiver operating characteristic curve demonstrated a QOD-NS of 8.0 as the optimal cutoff for a Youden's index of 0.23 for detection of dysosmia in aging patients.ConclusionsThe QOD-NS has significant, although weak correlation with psychophysical testing and psychosocial PROMs in aging subjects. However, a low Youden Index suggests limited potential of the QOD-NS as an OD screening tool in this population.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"105-111"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice Patterns and Outcomes of Dacryocystorhinostomy for Secondary Nasolacrimal Duct Obstruction.","authors":"Lily C Farrell, Piotr K Kopinski, Mohamad Rani Hassoun, Jeffrey P Graves, Janalee K Stokken, Andrea A Tooley, Elizabeth A Bradley, Lilly H Wagner","doi":"10.1177/19458924251386210","DOIUrl":"10.1177/19458924251386210","url":null,"abstract":"<p><p>BackgroundSinonasal pathology, such as chronic inflammatory disease or neoplasm, can cause secondary nasolacrimal duct obstruction (sNLDO). There is a paucity of data on dacryocystorhinostomy (DCR) techniques and outcomes for NLDO secondary to known sinonasal pathologies.ObjectiveTo describe case characteristics, management, and surgical outcomes of sNLDO at a tertiary academic center.MethodsCharts of DCR cases with at least 3 months follow-up done at a single institution over a 5-year period (2018-2022) were reviewed. Patient and surgical characteristics were recorded and compared between secondary and primary NLDO groups. The primary outcome was early functional success of DCR, assessed by improvement or resolution of epiphora at 3 months.ResultsA total of 236 cases were included. Of those, 79 (33.5%) were classified as secondary NLDO associated with sinonasal pathology. Reasons for sNLDO were sinonasal cancer (46.8%), chronic inflammatory disease (24.1%), trauma (16.5%), or prior head and neck radiation (31.6%). When comparing primary acquired NLDO to sNLDO cases, DCR for sNLDO was more likely to be performed endoscopically (68.4% vs 31.8%, <i>P</i> < .01), by a multidisciplinary team of rhinologist and oculoplastic surgeon (70.9% vs 8.3%, <i>P</i> < .01), and required bilateral surgery (36.7% vs 5.7%, <i>P</i> < .01). The overall functional success rate was 79.7% for sNLDO compared to 87.9% for primary acquired NLDO (<i>P</i> < .01). Revision surgery for sNLDO, history of sinonasal malignancy, and radiation were associated with lower functional success rates (66.7%, 70.3%, and 68.0%, respectively). Canalicular pathology was more common in sNLDO cases (29.0% vs 8.3%, <i>P</i> < .01).ConclusionsSecondary NLDO was more commonly managed with an endoscopic approach by a multidisciplinary team. Revisions for sNLDO, as well as cases with a history of sinonasal malignancy and radiation, had a markedly lower success rate, and sNLDO was frequently associated with canalicular obstruction. These findings may facilitate surgical planning and patient counseling.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"112-117"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12831806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Rhinology: Integrating Mechanisms, Measurement, and Multidisciplinary Care.","authors":"Stacey Tutt Gray","doi":"10.1177/19458924251415443","DOIUrl":"https://doi.org/10.1177/19458924251415443","url":null,"abstract":"","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"40 2","pages":"96-97"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}